Exploring Central Vascular Anatomy With Axial Computed Tomography During Surgery for Sigmoid Colon and Rectal Cancer: New Insights Into the Anatomical Relationship Between the Inferior Mesenteric Artery and the Duodenum

Background: In some individuals, the inferior mesenteric artery (IMA) originates from the aorta above the lower edge of the duodenum. This anatomical feature has rarely been reported but may be important in guiding central vascular ligation and lymph node dissection in colorectal surgery. This retrospective study aimed to explore the anatomical relationship between the IMA and the duodenum and evaluate its potential impact on the efficacy of D3 lymph node dissection.Methods: A total of 439 patients undergoing laparoscopic colorectal surgery at the Department of General Surgery, Qilu Hospital of Shandong University, were retrospectively enrolled. Clinical data from axial computed tomography (CT) scans were collected and analysed.Results: In 27.69% of patients, the IMA originated at or above the lower edge of the duodenum (median distance: −8 mm). These patients were characterised by a shorter superior mesenteric artery to aortic bifurcation distance, a superiorly located IMA origin, and a greater distance between the IMA and both the left colic artery and the inferior mesenteric vein. The number of harvested lymph nodes was not significantly associated with the distance between the IMA and the duodenum (P = 0.858).Conclusions: Preoperative axial CT scans can provide a great deal of information regarding central vascular anatomy in the context of sigmoid colon and rectal cancer surgery. Nearly one-third of patients have the IMA originating at or above the duodenum. Whether this anatomical feature affects D3 lymph node dissection warrants further investigation.

Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study

Purpose Although lumbar discectomy is the most common procedure in spine surgery, reports about anatomical relations between discs and prevertebral vessels are limited. Aim of this research was to investigate morphometric of the lumbar region and the relations between intervertebral discs (IVDs) and abdominal aorta. Methods 557 abdominal computed tomography scans were assessed. For each spinal column level from Th12/L1 down to L4/L5, we investigated: intervertebral disc’s and vertebra’s height, width, length, and distance from aorta or common iliac artery (CIA). Those arteries were also measured in two dimensions and classified based on location. Results 54.58% of patients were male. There was a significant difference in arterial-disc distances (ADDs) between genders at the levels: L1/L2 (1.32 ± 1.97 vs. 0.96 ± 1.78 mm; p = 0.0194), L2/L3 (1.97 ± 2.16 vs. 1.15 ± 2.01 mm; p < 0.0001), L3/L4 (2.54 ± 2.78 vs. 1.71 ± 2.61 mm; p = 0.0012), also for both CIAs (left CIA 3.64 ± 3.63 vs. 2.6 ± 3.06 mm; p = 0.0004 and right CIA: 7.96 ± 5.06 vs. 5.8 ± 4.57 mm; p < 0.001)—those ADDs were higher in men at all levels. The length and width of IVD increased alongside with disc level with the maximum at L4/L5. Conclusion Bifurcations of the aorta in most cases occurred at the L4 level. Collected data suggest that at the highest lumbar levels, there is a greater possibility to cause injury of the aorta due to its close anatomical relationship with discs. Females have limited, in comparison to males, ADD at L1/L2, L2/L3, and L3/L4 levels what should be taken into consideration during preoperative planning of surgical intervention.

Temporal Bone Landmarks of the Transversesigmoid Sinus Junction: An Anatomical Study in Dried Human Skulls

Objective: To investigate the accuracy in localization of the anterosuperior margin of TSSJ by using the intersection point between the squamosal and parietomastoid sutures (A point) and the intersection of the squamosal suture and supramastoid crest (B point) as bony landmarks.Materials and Methods: The A and B points were marked on the inner surface of a skull by using the transillumination technique. The anatomical relationship between the projected A point, B point, and groove of TSSJ was investigated in 60 dried Thai human skulls (120 sides).Results: Of the 120 sides, the projected A points were located exactly on the anterosuperior margin of the TSSJ in 38 (31.7%) instances and adjacent (above and below) the anterosuperior margin in 82 (68.3%) cases. Of the 118 sides with identifiable supramastoid crests, the projected B points were located precisely on the anterosuperior margin of TSSJ in 60 (50.8%) cases and above the anterosuperior margin of the TSSJ in 57 (48.3%) cases. Hence, the projected B point was a more reliable bony landmark for localizing the anterosuperior margin of the TSSJ when compared with the projected A point (p = 0.003, OR 2.2, and 95% CI =1.3-3.8).Conclusion: The B point is a more reliable temporal bone landmark for localization of the TSSJ than the A point. In temporal craniotomy, an initial burr hole at the B point is relatively safe and carries a very low risk of inadvertent venous sinus injury.

Influence of bone anatomical morphology of mandibular molars on dental implant based on CBCT

Background To apply CBCT to investigate the anatomical relationship between the mandibular molar and alveolar bone, aimed to provide clinical guidelines for the design of implant restoration. Methods 201 CBCT data were reevaluated to measure height of the alveolar process (EF), width of the alveolar process (GH), width of the basal bone (IJ), the angle between the long axis of the first molar and the alveolar bone (∠a) and the angle between the long axis of the alveolar bone and basal bone (∠b). The angle and width were measured to determine the implant-prosthodontic classification of the morphology in the left lower first molar (36) and right lower first molar (46). All measurements were performed on the improved cross-sectional images. Results EF, GH and IJ were measured as (10.83 ± 1.31) mm, (13.93 ± 2.00) mm and (12.68 ± 1.96) mm for 36, respectively; and (10.87 ± 1.24) mm, (13.86 ± 1.93) mm and (12.60 ± 1.90) mm for 46, respectively. No statistical significance was observed in EF, GH, IJ, ∠a and ∠b between 36 and 46 (all P > 0.05). The morphology was divided into three categories including the straight (68.7–69.2%), oblique (19.9–20.4%) and concave types (11%). Each type was consisted of two subcategories. Conclusions The proposed classification could provide evidence for appropriate selection and direction design of the mandibular molar implant in clinical. The concave type was the most difficult to implant with the highest risk of lingual perforation. The implant length, width, direction required more attention.

Effect of Laparoscopic Hysterectomy on Female Sexual Functions by Comparing their Preoperative and Post-Operative Sexual Performances using Female Sexual Function Index

Background: Hysterectomy is the most commonly performed gynecological procedure. It can affect female sexual functions in a number of ways mainly because of disruption of local nerve and blood supply and intimate anatomical relationship of pelvic organs. We intend to evaluate the effect of total laparoscopic hysterectomy (TLH) on female sexual function by comparing their preoperative and postoperative sexual performances using female sexual function index (FSFI). Materials and methods: The study was carried out in 50 hysterectomised patients over the duration of one year. Their sexual functions were assessed preoperatively prior to their admission in hospital. Then once hysterectomy is done, their postoperative sexual performances were assessed over the last four weeks period at least four months after their hysterectomy, using FSFI. Results: Out of 50 patients, 39 patients had undergone TLH with ovarian conservation and 11 had undergone TLH with bilateral salpingoophorectomy (BSO). Out of 50 participants, 27 had scores of less than 26 using FSFI, but after hysterectomy, 14 participants had scores of less than 26. The overall score using FSFI was improved from 24.26±2.2 to 28.11±2.2 (p-value <0.0001). Conclusion: Women can be positively reassured that hysterectomy performed for benign reasons does not negatively affect sexuality. TLH is less invasive in terms of causing damage to various pelvic nerves and vessels and hence causes less-to-no effect on female sexual functions. Key words: Hysterectomy, Sexual functions, Dyspareunia, Libido

Anatomical study between the correlation of the arcuate eminence and the superior semicircular canal

Objective To study the anatomical correlation between the arcuate eminence and the superior semicircular canal. Material and methods A study of the height of the arcuate eminence was carried out in 295 temporal bones. In addition, 30 temporals with different heights of the arcuate eminence (10 flat, 10 prominent and 10 very prominent) were randomly selected and radiological tests were performed by computed tomography (Pöschl projection) and subsequent dissection by milling until the apex of the superior semicircular canal was found, establishing, with both methods, the anatomical relationship with the arcuate eminence. Results The arcuate eminence was classified as: smooth, when there was no relief (1.7%); flat, measured less than 1 mm (20.3%), prominent, measured between 1 and 2 mm, in (62%), and very prominent, measured above 2 mm (12.6%). The tomographic study (CT) and its subsequent dissection by bone milling showed a direct relationship between the arcuate eminence and the semicircular canal only when it was flat, while the rest of the types corresponded to the presence of pneumatized peri-labyrinthine cells and/or cancellous bone without a direct anatomical relationship with the apex of the superior semicircular canal. Conclusion The correlation between the arcuate eminence and the superior semicircular canal is direct only when it is flat (1 mm), being related to peri-labyrinthine cells and/or cancellous bone when the arcuate eminence is prominent or very prominent.

Three-Dimensional Sheath Inked Rapid Acquisition with Refocused Echoes Imaging (SHINKEI) MRI for Delineating the Intraparotid Facial Nerve Branches and Their Anatomical Relationship with Parotid Tumors

Background: Accurate imaging of the anatomical relationship between the intraparotid facial nerve branches and parotid tumor can be helpful for surgical planning and effective protection of the facial nerve during surgery. Three-dimensional sheath inked rapid acquisition with refocused echoes imaging (3D-SHINKEI) is a new MRI sequence with a high tissue contrast resolution, which has been used for imaging the peripheral nerves in several organs. Objectives: To evaluate the value of 3D-SHINKEI sequence in representing the intraparotid facial nerve branches and their anatomical relationship with neoplasms of the parotid gland. Patients and Methods: Thirty-six patients with parotid tumors underwent MRI with 3D-SHINKEI and 3D-T2-fast field echo (3D-T2-FFE) sequences in the coronal plane. The contrast-to-noise ratios (CNRs) and signal intensity ratios (SIRs) of the facial nerves in the two sequences were compared. The relationship between the intraparotid facial nerve branches and parotid tumor was also analyzed in 36 patients, and the results were compared with the intraoperative anatomy and postoperative pathological findings. Results: The image quality score of the 3D-SHINKEI sequence for anatomical representation of the intraparotid facial nerve branches was significantly higher than that of the 3D-T2-FFE sequence (Z = −6.197, P < 0.01). The SIRs and CNRs of the facial nerves were significantly higher in the SHINKEI images as compared to the 3D-T2-FFE images (t = 10.772, P < 0.01 and t = 11.586, P < 0.01, respectively). The delineation accuracy of the anatomy of the main trunk of the facial nerve and its first-level branches and their relationship with tumors was significantly higher with the 3D-SHINKEI sequence than with the 3D-T2-FFE sequence (P < 0.01). Besides, the relationship between parotid tumors and the main trunk of the facial nerve and its first-level branches was classified into six types. Conclusion: A high-resolution 3D-SHINKEI sequence could accurately represent the relationship between the intraparotid facial nerve branches and parotid gland neoplasms. It was also found to be more accurate than the 3D-T2-FFE sequence.

The safe zones for endoscopic proximal hamstring repair: a cadaveric assessment of standard portal placement and their relationship to major neurovascular structures

Purpose: To define the anatomical relationship of the major neurovascular structures to the standard endoscopic portals used in endoscopic hamstring repair. A secondary outcome was to determine the safest angle of insertion from each standard portal. Methods: Endoscopic portals were established in the 3 standard locations (lateral, medial, and inferior) and Steinmann pins inserted at various angles. Each hip was dissected and the distance between the pins and the pertinent anatomy measured. Results: The lateral portal placed the sciatic and posterior femoral cutaneous (PFC) nerves at greatest risk: direct injury to the sciatic nerve was seen in 11/30 (37%) of the lateral portals sited. A lateral portal with an approach at 60° was the most dangerous orientation with a mean distance of 0.36 ± 0.49 mm and 4.30 ± 2.69 mm from the sciatic and PFC nerves, respectively ( p < 0.001). The 60° medial portal was the safest of all portals measured, at a mean distance of 67.37 ± 11.06mm (range, 47–78 mm) from the sciatic nerve and 58.90 ± 10.57 mm (range 40–70 mm) from the PFC nerve. Conclusions: While currently described techniques recommend establishing the standard lateral portal first, this study shows that it carries the highest risk of injury if used blind. We recommend that the standard medial endoscopic portal is established first to identify the neurovascular structures and minimise iatrogenic neurovascular injury. The inferior and lateral portals can then be established created under direct vision. The lateral portal should be inserted in a more horizontal orientation to decrease the risk of nerve injury.